BMJ:房颤或机械性心脏瓣膜植入患者不需要侵入性手术后抗凝桥接治疗

2021-06-10 MedSci原创 MedSci原创

房颤以及接受心脏机械瓣膜植入的患者需接受持续的抗凝治疗,主要是维生素k拮抗剂,但由于侵入性手术,患者需中断华法林治疗。抗凝桥接治疗的目的是尽可能减少房颤患者脱离规律抗凝治疗的时间。

房颤以及接受心脏机械瓣膜植入的患者需接受持续的抗凝治疗,主要是维生素k拮抗剂,但由于侵入性手术,患者需中断华法林治疗。抗凝桥接治疗的目的是尽可能减少房颤患者脱离规律抗凝治疗的时间。近日研究人员考察了术后低分子量肝素(LMWH) 桥接的安全性及效果。

本次研究在加拿大和印度的10个临床中心开展,1471名成年房颤或机械性心脏瓣膜植入患者参与,术后随机接受达肝素钠(n=821;1名患者在随机分组后退出)或安慰剂(n=650)。研究的主要终点为严重血栓(包括中风、短暂性缺血发作、近端深静脉血栓、肺栓塞、心肌梗死、外周栓塞或血管死亡)和90天内大出血风险。

安慰剂组90天内主要血栓栓塞的发生率为1.2%(650例患者中有8例),达肝素钠组为1.0%(820例患者中有8例,危险差异:-0.3%)。安慰剂组大出血发生率为2.0%(650例患者中13例),达肝素钠组大出血发生率为1.3%(820例患者中11例,危险性差异:0.7%)。患者基线房颤或植入机械心脏瓣膜对结果无显著影响。

研究认为,由于手术而中断华法林抗凝治疗的房颤或机械性心脏瓣膜植入患者,术后达肝素钠桥接对预防主要血栓风险无显著作用。

原始出处:

Michael J Kovacs et al. Postoperative low molecular weight heparin bridging treatment for patients at high risk of arterial thromboembolism (PERIOP2): double blind randomised controlled trial.BMJ. June 09,2021.

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    2022-02-13 gaoxiaoe
  5. [GetPortalCommentsPageByObjectIdResponse(id=1798290, encodeId=020f1e98290a2, content=<a href='/topic/show?id=f5b568e8451' target=_blank style='color:#2F92EE;'>#瓣膜植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68784, encryptionId=f5b568e8451, topicName=瓣膜植入)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b7c20, createdName=wjcjjian, createdTime=Thu Jan 20 17:38:52 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2028823, encodeId=f3b02028823f8, content=<a href='/topic/show?id=b1e1269e5c6' target=_blank style='color:#2F92EE;'>#侵入性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26975, encryptionId=b1e1269e5c6, topicName=侵入性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4736501, createdName=xiaoyang_ambs, createdTime=Tue Aug 24 02:38:52 CST 2021, time=2021-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1715965, encodeId=f8711e15965c4, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Sat Apr 02 23:38:52 CST 2022, time=2022-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849269, encodeId=491e184926914, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Feb 13 19:38:52 CST 2022, time=2022-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520752, encodeId=774c1520e5286, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Sat Jun 12 11:38:52 CST 2021, time=2021-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583688, encodeId=c4e9158368815, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sat Jun 12 11:38:52 CST 2021, time=2021-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031409, encodeId=72c51031409f2, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Thu Jun 10 23:38:52 CST 2021, time=2021-06-10, status=1, ipAttribution=)]
    2021-06-12 jiyangfei
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    2021-06-10 心介

    房颤,临床上碰到很多哦

    0

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